Organ donation in the North Italy Transplant program.
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Biomedical subjects
Publications and source records attributed to C Pizzi.
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NITp is an organization that since 1972 has served an area of approximately 17 million inhabitants through 8 transplant centers, 20 active donor-procuring centers, and 1 coordinating center. The activity of NITp can be divided into three historical periods. In the first period (1972-1977, 408 transplants), collaboration was initiated and protocols implemented. In the second (1978-1982, 592 transplants), a policy was established as follows: three deliberate transfusions of standard packed red cells were given pretransplant to all untransfused patients on the waiting list. Priority was given to immunized patients when an HLA-A, -B-compatible kidney was available and an effort was made to ensure at least two HLA-A, -B matches to nonimmunized patients. All transplanted patients were treated with conventional therapy (corticosteroids and azathioprine). Evaluation of data of this period showed that both graft and patient survival had increased; a center effect was evident; the policy of giving a kidney with at least two HLA-A, -B matches seemed to improve the results; and preformed panel-reacting antibodies had a negative effect on graft survival. The third period began in January 1983 when some centers in the NITp started to use CsA. By December 31, 1985, 589 of 863 transplants performed had been treated with CsA. Data analysis showed that CsA significantly increased the one-year success rate in both first and second transplants; other factors, such as HLA-A, -B and -DR matching, transplant center, old age of the kidney donor (51-60 years), and cold and warm ischemia times seemed less or not important. Preformed panel-reacting lymphocytotoxic antibodies did not influence graft outcome significantly, but a trend was observed in that immunized recipients did worse than non-immunized recipients. The transfusion effect could not be evaluated in our CsA patients since they all are transfused pretransplant; a prospective study is necessary to evaluate if such an effect is still present. Until more data are collected in our setting to allow a sound evaluation of the consequences of CsA treatment, no changes are warranted in the NITp policy.
A controlled clinical trial was started to evaluate whether small doses of blood given pretransplant determine a transfusion effect while reducing the risk of antibody production. For this purpose, 65 consecutive never transfused patients suffering from end-stage renal failure were assigned to one of two groups: the first group was transfused with 1 unit of packed red cells (containing a mean of 2350 x 10(6) leukocytes, 900 x 10(6) mononuclear cells) 3 times at 15-day intervals. The second group received one transfusion of about 30 ml of blood adjusted to contain 100 x 10(6) mononuclear cells. While no definitive conclusions are still possible, preliminary data indicate the following: (1) three small transfusions are capable of immunizing the recipient, but lymphocytotoxic antibodies tend to disappear rapidly; (2) in vitro lymphocyte response to lectins of patients receiving small transfusions is not significantly different from that of patients receiving standard transfusions; (3) the two groups of patients differ significantly as far as the T4+ /T8+ cell ratio is concerned: in fact while a decrease of the ratio is observed after standard transfusions, small transfusions determine an increase of the ratio, mainly due to a decrease in the number of T8+ cells; and (4) the clinical course and survival of the graft is worse in patients treated with small transfusions than in those treated with standard transfusions.
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A retrospective investigation was carried out to evaluate the infuence of HLA (A, B) matching, blood transfusions, and preexistence of lymphocytotoxic antibodies on the outcome of the cadaver kidney graft: only non-NIH standard antibodies were considered, since patients with NIH standard antibodies do not undergo transplantation in the programme of Milano. It was found that (1) about one-half the patients with transplants had antibodies in their pretransplant serum. The preexistence of antibodies directed against B lymphocytes had an unfavourable effect on the graft survival; (2) the graft did particularly well in the nonimmunized patients who had been previously transfused; the graft survival was about 80% at 3 years in these patients; and (3) the HLA (A, B) match influenced the graft survival only in patients with antibodies.
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Clinical data of 92 patients with primary breast carcinomas previously analysed for the pattern of immunohistochemical expression of three distinct carbohydrate epitopes of the TAG-72 molecule were reviewed. The clinical outcome of the patients after a median follow-up of 66 months was determined in 84 out of 92 patients. Clinicopathological characteristics of the tumours and clinical outcome of the patients were correlated with the TAG-72 epitope expression. TAG-72 was expressed more frequently in patients aged more than 50 years and in tumours of larger size, with lymph nodes metastasis, with low differentiation and with high proliferative activity. A statistical correlation was found with more advanced stages of the disease (35.7% vs 60% in stage I and in stage II-III, respectively, p=0.03). Disease-free survival and overall survival were estimated by the Kaplan-Meier method. The survival of the patients with tumours expressing TAG-72 was not statistically different from that of patients with tumours without TAG-72 expression. These data suggest that TAG-72 expression is associated with clinicopathological parameters of aggressiveness in primary breast cancer, but it does not appear to affect the clinical outcome of the patients.
Renal transplantation is an effective therapeutic tool for patients with end-stage renal diseases (ESRDs). Data reported in this article summarize the results obtained from 30 years' activity in the North Italy Transplant program (NITp), the first transplant organization in Italy that implemented a donor procurement and organ transplantation network. In the NITp kidney allocation is governed by a computerized algorithm, NITK3, put in place in 1997, aimed at ensuring equity, transparency and traceability during the stages of the allocation decision-making process. The NITp working group has recognized the NITK3 criteria and they are periodically reviewed following the results of the analysis of patients' transplantation odds. The results obtained with the use of the NITK3 algorithm have been very satisfactory: after 6 yrs, a significantly higher percentage of patients at immunological risk (sensitized or waiting for re-transplant), of patients waiting for >3 yrs and of patients with 0-1 HLA A,B,DR mismatches have been transplanted. Moreover, a higher percentage of kidneys were used locally (in a hospital within the procurement area), and this is known to stimulate donor procurement. Finally, we performed a preliminary statistical analysis of transplants carried out from 1998-2002 in 5/16 centers of the NITp area, demonstrating the quality of the NITp program in terms of patient and graft survival, and that donor and recipient age are the variables significantly impacting on transplant results.
The staging, therapy and course of 91 patients with extranodal NHL of the head and neck treated between 1970 and 1985, were analyzed. The sites involved were: Waldeyer's ring 71 patients, tonsil 59, nasopharynx 12 and extralymphatic sites 20 patients (larynx 6, paranasal sinus 5, orbit 5, oral cavity 3, salivary gland 1). Sixty-three patients had unfavourable histology with 22 patients in stage I; 33 in II; 21 in III; 15 in IV. Chemotherapy plus radiotherapy was used in 43 patients and 34 obtained Complete Remission (CR). Chemotherapy alone was used in 30 patients and in 11 CR was achieved, radiotherapy alone in 18 patients and 11 obtained CR. The actuarial survival rate was 55% and recurrence-free survival, evaluated only in those patients who achieved complete remission, was 80%. Results, as survival and freedom from recurrence, are analyzed in relation to main prognostic factors and therapy, and patterns of recurrence are reported. The present study confirmed the view that radiotherapy combined with chemotherapy represents the best treatment for NHL of the head and neck.